- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,121.32 / $1,544.65 / $2,493.16
| Professional | | $1,121.32 | $1,544.65 | $2,493.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.94 / $2,475.57 / $10,709.20
| Professional | | $1,198.94 | $2,475.57 | $10,709.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,426.44 / $2,306.94 / $4,100.01
| Professional | | $1,426.44 | $2,306.94 | $4,100.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,682.04 / $2,037.50 / $2,785.09
| Professional | | $1,682.04 | $2,037.50 | $2,785.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,430.82 / $3,027.69 / $4,149.08
| Professional | | $1,430.82 | $3,027.69 | $4,149.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,694.73 / $3,164.88 / $10,709.20
| Professional | | $1,694.73 | $3,164.88 | $10,709.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,607.09 / $2,359.46 / $4,339.16
| Professional | | $1,607.09 | $2,359.46 | $4,339.16 |